Using NLP and AI to Drive Better Clinical Actions and Outcomes: How HealthSource Brings it Together

Eugenia Ross, VP Business DevelopmentCiox Health

Agenda

> The state of data in healthcare

> How NLP and AI are shaping the future state of clinical data

> How HealthSource helps drive better clinical actions and outcomes

Current state of clinical data –unstructured and inaccessible

80%UNSTRUCTURED

20%STRUCTURED

Clinical data are transitioning from handwritten and faxed to electronic records, but are still largely in unstructured form

Advanced technologies are transforming the way data are accessed and used

EMR connectivity NLP / Machine learning

Cloud storage

• More and more data are generated and stored in structured formats

• Connectivity standards are making it easier to access and exchange medical records in electronic format

• Automated data extraction is making data usable at scale

• New levels of accuracy through advances in machine learning

• Many more data elements can be extracted and analyzed for a deeper understanding of each patient

• Cloud storage has dramatically lowered the cost of holding large amounts of data

NLP and AI technologies are helping unlock the value of unstructured data

Natural language processing (NLP) use is becoming mainstream

• Evidence of accuracy and productivity benefits growing• Automated data structuring allows at-scale data analytics• Reuse of data across risk, quality and care management lessens administrative

demands on both providers and health plans

5

CCD

Medical record

The technology is here to stay. Health plans can achieve a new level of data insights with the

right partner

OCR & NLP

How NLP and AI are shaping the future state of clinical data

The new world of clinical data

Taxonomy

Optical Character

Recognition (OCR)

Clinical Rules

Business Intelligence

Machine Learning/Artificial

Intelligence

NLP

C L I N I C A L D ATA : M I N E , E X T R A C T, T R A N S F O R M A N D R E U S E

NLP and AI use in healthcare is expanding rapidly

Why now?• Artificial intelligence improvements

• Large-scale investments in technology

• Refined clinical rules

• Refined taxonomies

Computer-assisted coding – in use for 10+ years at inpatient facilities

Technology-enabled HCC coding – expanding use across health plans

AI-enabled clinical research –significant advances in data mining for clinical studies

NLP has become operationally viable, with high accuracy for information found and low rate of omissions

We now have the capability to configure the technology dynamically to meet business needs

Beyond coding: New uses for NLP in risk and quality• Prioritization of charts and members

for coding• Business intelligence for input into

suspecting analytics • Ongoing, year-round understanding

of care gaps• Predictive analytics for member

engagement and follow-up• Insights to power engagement with

providers on documentation

The next frontier: convergence of risk, quality and care management

RISK ADJUSTMENT

QUALITY / FIVE STAR

CLINICAL OUTCOMES

Future state:• True longitudinal view of the member, leveraging data aggregated

across claims, risk and quality into a single enterprise repository• Ubiquitous access to granular data, powered by automated

abstraction with improved accuracy and productivity for more complete results

• Continuous insight and action model with year-round impact

Current state:

• Distinct domains within health plans

• Separate data collection and member databases

• Separate analytics, largely informed by claims with limited clinical data

How HealthSource helps drive better clinical actions and outcomes

The HealthSource platform provides accelerated access to member medical records

Medical Charts HRAs

Client Metadata

Claims RxLab

MembershipPCP Enrollment

CMS RAPS/EDPS

Smart ChartOCR NLP

CCDsCCD-As

HL7Health-Source

HIE

Stru

ctur

ed D

ata

Uns

truc

ture

d D

ata

Client

CiOX / Client Document Storage (DS)

Documents

Structured Storage (ST)

Big Data (DL)

HealthSource Vault: Clinical

Data Warehouse

Unstructured / Raw Data Files

Clinical Data

Chart Data

Provider Data

Member Data

EMR FeedsTranslation and Normalization

Clinical Data ETL

Medical records

Members DataMedical Records

MRA, CRA, HEDIS

Clinical dataCLAIMS

RX, MOR, MMR, RAPS, MBR,,,,

EMR connections

DX, DOS, PCP,RX, etc.

CPT, DX, RX, HCC

CPT, DX, RX, HCC

DataAnalytics

DashboardsSmart VisualizationsAPIs and Streams

HealthSource comprises several interlocked capabilities which create a seamless data platform

Smart Chart

UI & data delivery

Vault

Analytics

Several interlocking components create a seamless data platform that allows data access and management across administrative, quality and clinical use cases

• Large-scale access to EMR structured data and full medical records – more than 50% of records accessed through EMR connection by end-2018

• Use of advanced OCR and NLP technologies to extract clinical data from medical records for fast and easy access to member data

• Intuitive dashboards and visualizations for easy access to and understanding of the data, along with APIs for data delivery into clients’ systems

• Member-centric data repository enabling the creation of longitudinal views of members’ health records

• Extensive analytics on members, providers and cohorts allowing member identification and targeting across health plan use cases

• The industry’s largest provider database powers insights on provider behavior and campaign prospects for risk, quality and other use cases

EMR connectivity

Aggregation IQ

HealthSource - 360 Member View

Member

Payers

General Practitioners

Diagnostic Centers

Laboratories

Pharmacies

Specialty Providers

Home Health Providers

Claims and Encounter

(Medical & Rx)

HEDIS Data

Retrospective Medical Charts

Patient Assessment Forms (PAF)

Health Risk Assessments

(HRA)

Members’ data are continuously enriched and broadened with each touchpoint across various healthcare stakeholders

HealthSource allows data access across use cases and departments

15

Benefits• Reduced cost of care and improved

medical cost trend• Early identification of gaps and potential

interventions• Increased compliance, and adherence • Improved member engagement and health

outcomes• Reduced cost to track and prevent FWA• Higher member and provider satisfaction• Increased revenue from value-based care

programs

• Risk adjustment

• HEDIS/STAR ratings

• Gaps in care

• Care coordination

• Payment integrity

• Prior authorization

• Population health analysis

• Patient engagement

c

Health plan use cases

Thank You!

Questions?